National Guideline Clearinghouse (NGC). Guideline synthesis

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Areas of Agreement Assessment of Pressure Ulcer Risk Both guidelines agree on the need for timely assessment of pressure ulcer risk and most explicitly recommend a combination of informal (i.e., clinical judgment) and formal (i.e., use of a risk assessment tool) methods. As a formal risk assessment method, use of a standardized tool is recommended by both guidelines. The Braden Scale and the Norton Scale are mentioned as appropriate instruments by both groups. Both guidelines also agree on the need for reassessment when a patient's clinical condition changes, or on a regular basis for high-risk patients. Skin Care and Protection Both guidelines address skin care as a prevention intervention and recommend daily assessment of skin. There is overall agreement that keeping the skin dry and moisturized is an important prevention step. Both guidelines stress the need to avoid vigorous massage, especially over bony prominences. They also address the need to protect the skin from friction and shear, particularly during transfer and repositioning, as well as the need to manage moisture from incontinence. RNAO specifically recommends establishing a bowel and bladder program for incontinent patients. Positioning and Pressure-Relieving Devices Recommendations concerning positioning and pressure-relieving devices are similar between guidelines, with both noting the need for frequent repositioning of bed-bound and chair-bound patients and the need to use pressure-reducing mattresses and positioning devices such as wedges and pillows. Both groups recommend use of a written repositioning schedule and caution against the use of doughnut-type devices. RNAO specifically cites the need for use of a pressurerelieving mattress during surgery for at-risk patients. Nutrition Both groups stress the importance of adequate nutrition as a part of pressure ulcer prevention. HIGN cites the need for adequate hydration, protein, calories, and vitamins A, C, and E. Both guidelines recommend consultation with a dietitian to assess nutritional needs and develop a nutritional support plan. Patient, Carer, and Professional Education The need for education aimed at patients, carers, and professional staff is recommended by both groups. The groups are in agreement that educational programs should be structured, organized, comprehensive, and directed at all levels of healthcare providers, patients, and families or caregivers. RNAO stresses the importance of incorporating updated information and new technologies into educational programs. Other Interventions 16 of 17
RNAO notes that pain has an impact on the risk for developing pressure ulcer by limiting a patient's mobility and, therefore, needs to be assessed and managed. They also include recommendations for creating a plan of care for transferring patients to another location and for implementing a rehabilitation program, when feasible, to improve patient mobility. HIGN urges the importance of monitoring the effectiveness of prevention interventions as well as the healing of any existing pressure ulcers. Areas of Differences There are no significant areas of difference between the guidelines. This Synthesis was prepared by ECRI on October 31, 2006. The information was verified by UIGN on November 21, 2006, by AMDA and WOCN on December 5, 2006, and by RNAO on December 11, 2006. This summary was updated by ECRI Institute on July 30, 2007 following the withdrawal of the Singapore Ministry of Health guideline from the NGC Web site. This synthesis was updated on December 12, 2007 to remove UIGN recommendations, and on September 12, 2008 to update HIGN recommendations and to remove NCCNSC/NICE and WOCN recommendations. Internet citation: National Guideline Clearinghouse (NGC). Guideline synthesis: Pressure Ulcer Prevention. In: National Guideline Clearinghouse (NGC) [website]. Rockville (MD): 2006 Dec (revised 2008 Sep). [cited YYYY Mon DD]. Available: http://www.guideline.gov. © 1998-2008 National Guideline Clearinghouse Date Modified: 9/22/2008 17 of 17
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Page 15: common language. Ostomy Wound Manag

National Guideline Clearinghouse (NGC). Guideline synthesis

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